Introduction Extraction of large (>1 cm) CBD stones at ERCP is often difficult despite adequate sphincterotomy. Failure of extraction of stones warrants repeat ERCPs and also referral to advanced techniques such as extracorporeal shock wave lithotripsy which is not readily available in UK centres. We believe that balloon sphincteroplasty is a safe and effective procedure which is underutilised. We describe a large district general hospital experience of use of balloon sphincteroplasty in a cohort of elderly patients.
Methods All patients who underwent balloon sphincteroplasty since June 2012 at Princess Royal Hospital, Bromley were identified from endoscopy database. Patients demographics, sedation dose, size of balloon sphincteroplasty, success rate of CBD stones clearance and complications were examined.
Results A Total of 29 patients underwent balloon sphicteroplsty. 8 (27%) of these patients had previous unsuccessful attempt at ERCP removal of stones. All patients had sphincterotomy prior to sphincteroplasty. Mean age of patients was 72 years. There were 20 female and 9 male patients. Mean dose of Midazolam was 4 mg and Fentanyl 75 mg. Mean size of the CBD stones in these patients was 13 mm (range 10–20 mm). 8 patients had large peri-ampullary diverticulum (6 patients had ampulla at the edge of diverticulam, one <5 mm).
Balloon sphincterotoplasty using Boston Scientific CRE balloon was performed. Mean size of balloon sphincteroplasty was 14 mm (range 10–20 mm and median 15 mm). Stone retrieval basket was used in 6 patients. Complete extraction of CBD stones was documented in 28 of 29 (97%) patients.
One patient developed uncomplicated pancreatitis who recovered with conservative management. One patient had minor bleeding which settled spontaneously. None of the patients had perforations. Stone clearance was incomplete in one patient due to to a small proximal stone floated up in to the left hepatic duct. On median follow up of 6 months 1 patient underwent repeat ERCP for recurrence of stones.
Conclusion In our district general hospital cohort of elderly patients, Balloon sphincteroplasty was found to be safe and effective procedure in extraction of large common bile duct stones. Complete extraction of CBD stones was achieved in 97% of patients. One patient had mild pancreatitis, one had mild bleeding and there was no of perforations observed. Balloon sphincteroplasty was particularly useful in patients with peri-ampullary divericulm in whom a generous sphincterotomy could be risky. Balloon sphincteroplasty had prevented the further need for ERCP, and its associated cost and morbidity.
Reference Maydeo A, Bhandari S, et al., Endoscopy 2007; 39 (11)
Disclosure of Interest None Declared.
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